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Baymon DE, Vakkalanka JP, Krishnadasan A, Mohr NM, Talan DA, Hagen MB, Wallace K, Harland KK, Aisiku IP, Hou PC. Race, Ethnicity, and Delayed Time to COVID-19 Testing Among US Health Care Workers. JAMA Netw Open 2024; 7:e245697. [PMID: 38598239 PMCID: PMC11007575 DOI: 10.1001/jamanetworkopen.2024.5697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/12/2024] [Indexed: 04/11/2024] Open
Abstract
Importance Access to COVID-19 testing is critical to reducing transmission and supporting early treatment decisions; when made accessible, the timeliness of testing may also be an important metric in mitigating community spread of the infection. While disparities in transmission and outcomes of COVID-19 have been well documented, the extent of timeliness of testing and the association with demographic factors is unclear. Objectives To evaluate demographic factors associated with delayed COVID-19 testing among health care personnel (HCP) during the COVID-19 pandemic. Design, Setting, and Participants This cross-sectional study used data from the Preventing Emerging Infections Through Vaccine Effectiveness Testing study, a multicenter, test-negative, case-control vaccine effectiveness study that enrolled HCP who had COVID-19 symptoms and testing between December 2020 and April 2022. Data analysis was conducted from March 2022 to Junne 2023. Exposure Displaying COVID-19-like symptoms and polymerase chain reaction testing occurring from the first day symptoms occurred up to 14 days after symptoms occurred. Main Outcomes and Measures Variables of interest included patient demographics (sex, age, and clinical comorbidities) and COVID-19 characteristics (vaccination status and COVID-19 wave). The primary outcome was time from symptom onset to COVID-19 testing, which was defined as early testing (≤2 days) or delayed testing (≥3 days). Associations of demographic characteristics with delayed testing were measured while adjusting for clinical comorbidities, COVID-19 characteristics, and test site using multivariable modeling to estimate relative risks and 95% CIs. Results A total of 5551 HCP (4859 female [82.9%]; 1954 aged 25-34 years [35.2%]; 4233 non-Hispanic White [76.3%], 370 non-Hispanic Black [6.7%], and 324 non-Hispanic Asian [5.8%]) were included in the final analysis. Overall, 2060 participants (37.1%) reported delayed testing and 3491 (62.9%) reported early testing. Compared with non-Hispanic White HCP, delayed testing was higher among non-Hispanic Black HCP (adjusted risk ratio, 1.18; 95%CI, 1.10-1.27) and for non-Hispanic HCP of other races (adjusted risk ratio, 1.17; 95% CI, 1.03-1.33). Sex and age were not associated with delayed testing. Compared with clinical HCP with graduate degrees, all other professional and educational groups had significantly delayed testing. Conclusions and Relevance In this cross-sectional study of HCP, compared with non-Hispanic White HCP and clinical HCP with graduate degrees, non-Hispanic Black HCP, non-Hispanic HCP of other races, and HCP all other professional and education backgrounds were more likely to have delayed COVID-19 testing. These findings suggest that time to testing may serve as a valuable metric in evaluating sociodemographic disparities in the response to COVID-19 and future health mitigation strategies.
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Affiliation(s)
- DaMarcus E. Baymon
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - J. Priyanka Vakkalanka
- Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
| | - Anusha Krishnadasan
- Olive View-University of California, Los Angeles Education and Research Institute, Los Angeles
| | - Nicholas M. Mohr
- Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
- Department of Anesthesia Critical Care, Carver College of Medicine, University of Iowa, Iowa City
| | - David A. Talan
- Olive View-University of California, Los Angeles Education and Research Institute, Los Angeles
- David Geffen School of Medicine, University of California, Los Angeles
| | - Melissa Briggs Hagen
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control & Prevention, Atlanta, Georgia
| | - Kelli Wallace
- University of Iowa Holden Comprehensive Cancer Center, University of Iowa, Iowa City
| | - Karisa K. Harland
- Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City
| | - Imoigele P. Aisiku
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Peter C. Hou
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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Oliveira TM, Billington ME, Seethala RR, Hou PC, Askari R, Aisiku IP. Differences in Prevalence of Transfusion Protocols between Critically Ill Neurologic and Non-Neurologic Patient Populations. J Clin Med 2023; 12:6633. [PMID: 37892771 PMCID: PMC10607520 DOI: 10.3390/jcm12206633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/03/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023] Open
Abstract
This study describes the prevalence of blood transfusion protocols in ICUs caring for neurologically vs. non-neurologically injured patients across a sample of US ICUs. This prospective, observational multi-center cohort study is a subgroup analysis of the USCIITG-CIOS, comprising 69 ICUs across the US (25 medical, 24 surgical, 20 mixed ICUs). Sixty-four ICUs were in teaching hospitals. A total of 6179 patients were enrolled, with 1266 (20.4%) having central nervous system (CNS) primary diagnoses. We evaluated whether CNS versus non-CNS diagnosis was associated with care in ICUs with restrictive transfusion protocols (RTPs) or massive transfusion protocols (MTPs) and whether CNS versus non-CNS diagnosis was associated with receiving blood products or colloids during the initial 24 h of care. Protocol utilization in CNS vs. non-CNS patients was as follows: RTPs-36.9% vs. 42.9% (p < 0.001); MTPs-48.3% vs. 47.4% (p = 0.57). Blood product transfusions in the first 24 h of ICU care (comparing CNS vs. non-CNS patients) were as follows: packed red blood cells-4.3% vs. 14.6% (p < 0.001); fresh frozen plasma-2.9% vs. 5.1% (p < 0.001); colloid blood products-3.2% vs. 9.2% (p < 0.001). In this cohort, we found differences in ICU utilization of RTPs, but not MTPs, when comparing where critically ill patients with neurologic versus non-neurologic primary diagnoses received ICU care.
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Affiliation(s)
- Thiago M Oliveira
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Michael E Billington
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Raghu R Seethala
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Peter C Hou
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Reza Askari
- Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Imoigele P Aisiku
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
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Carreras Tartak JA, Brisbon N, Wilkie S, Sequist TD, Aisiku IP, Raja A, Macias‐Konstantopoulos WL. Racial and ethnic disparities in emergency department restraint use: A multicenter retrospective analysis. Acad Emerg Med 2021; 28:957-965. [PMID: 34533261 DOI: 10.1111/acem.14327] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Research regarding disparities in physical restraint use in the emergency department (ED) is limited. We evaluated the role of race, ethnicity, and preferred language on the application of physical restraint among ED patients held under a Massachusetts section 12(a) order for mandatory psychiatric evaluation. METHODS We identified all ED patient encounters with a section 12(a) order across a large integrated 11-hospital health system from January 2018 through December 2019. Information on age, race, ethnicity, preferred language, insurance, mental illness, substance use, history of homelessness, and in-network primary care provider was obtained from the electronic health record. We evaluated for differences in physical restraint use between subgroups via a mixed-effect logistic regression with random-intercept model. RESULTS We identified 32,054 encounters involving a section 12(a) order. Physical restraints were used in 2,458 (7.7%) encounters. Factors associated with physical restraint included male sex (adjusted odds ratio [aOR] = 1.44, 95% confidence interval [CI] = 1.28 to 1.63), Black/African American race (aOR = 1.22, 95% CI = 1.01 to 1.48), Hispanic ethnicity (aOR = 1.45, 95% CI = 1.22 to 1.73), Medicaid insurance (aOR = 1.21, 95% CI = 1.05 to 1.39), and a diagnosis of bipolar disorder or psychotic disorder (aOR = 1.51, 95% CI = 1.31 to 1.74). Across all age groups, patients who were 25 to 34 years of age were at highest risk of restraint (aOR = 2.01, 95% CI = 1.69 to 2.39). Patients with a primary care provider within our network (aOR = 0.81, 95% CI = 0.72 to 0.92) were at lower risk of restraint. No associations were found between restraint use and language, history of alcohol or substance use, or homelessness. CONCLUSION Black/African American and Hispanic patients under an involuntary mandatory emergency psychiatric evaluation hold order experience higher rates of physical restraint in the ED. Factors contributing to racial disparities in the use of physical restraint, including the potential role of structural racism and other forms of bias, merits further investigation.
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Affiliation(s)
| | - Nicholas Brisbon
- Data and Analytics Organization Mass General Brigham Boston Massachusetts USA
| | - Sarah Wilkie
- Department of Quality and Patient Experience Mass General Brigham Boston Massachusetts USA
| | - Thomas D. Sequist
- Department of Quality and Patient Experience Mass General Brigham Boston Massachusetts USA
| | - Imoigele P. Aisiku
- Department of Emergency Medicine Brigham and Women’s Hospital Boston Massachusetts USA
| | - Ali Raja
- Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA
| | - Wendy L. Macias‐Konstantopoulos
- Department of Emergency Medicine Center for Social Justice and Health Equity Massachusetts General Hospital Boston Massachusetts USA
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Yamal JM, Aisiku IP, Hannay HJ, Brito FA, Robertson CS. Disability Rating Scale in the First Few Weeks After a Severe Traumatic Brain Injury as a Predictor of 6-Month Functional Outcome. Neurosurgery 2021; 88:619-626. [PMID: 33369651 PMCID: PMC7884144 DOI: 10.1093/neuros/nyaa474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 08/23/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND An early acute marker of long-term neurological outcome would be useful to help guide clinical decision making and therapeutic effectiveness after severe traumatic brain injury (TBI). We investigated the utility of the Disability Rating Scale (DRS) as early as 1 wk after TBI as a predictor of favorable 6-mo Glasgow Outcome Scale extended (GOS-E). OBJECTIVE To determine the predictability of a favorable 6-mo GOS-E using the DRS measured during weeks 1 to 4 of injury. METHODS The study is a sub analysis of patients enrolled in the Epo Severe TBI Trial (n = 200) to train and validate L1-regularized logistic regression models. DRS was collected at weeks 1 to 4 and GOS-E at 6 mo. RESULTS The average area under the receiver operating characteristic curve was 0.82 for the model with baseline demographic and injury severity variables and week 1 DRS and increased to 0.88 when including weekly DRS until week 4. CONCLUSION This study suggests that week 1 to 4 DRS may be predictors of favorable 6-mo outcome in severe TBI patients and thus useful both for clinical prognostication as well as surrogate endpoints for adaptive clinical trials.
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Affiliation(s)
- Jose-Miguel Yamal
- Department of Biostatistics and Data Science, The University of Texas School of Public Health, Houston, Texas
| | - Imoigele P Aisiku
- Department of Emergency Medicine, Harvard Medical School/Brigham and Women's Hospital, Boston, Massachusetts
| | - H Julia Hannay
- Department of Psychology and Texas Institute for Measurement Evaluation and Statistics (TIMES), University of Houston, Houston Texas
| | - Frances A Brito
- Department of Biostatistics and Data Science, The University of Texas School of Public Health, Houston, Texas
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George N, Elie-Turenne MC, Seethala RR, Baslanti TO, Bozorgmehri S, Mark K, Meurer D, Bihorac A, Aisiku IP, Hou PC. External Validation of the qSOFA Score in Emergency Department Patients With Pneumonia. J Emerg Med 2019; 57:755-764. [DOI: 10.1016/j.jemermed.2019.08.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/18/2019] [Accepted: 08/26/2019] [Indexed: 10/25/2022]
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Vahidy FS, Haque ME, Rahbar MH, Zhu H, Rowan P, Aisiku IP, Lee DA, Juneja HS, Alderman S, Barreto AD, Suarez JI, Bambhroliya A, Hasan KM, Kassam MR, Aronowski J, Gee A, Cox CS, Grotta JC, Savitz SI. Intravenous Bone Marrow Mononuclear Cells for Acute Ischemic Stroke: Safety, Feasibility, and Effect Size from a Phase I Clinical Trial. Stem Cells 2019; 37:1481-1491. [PMID: 31529663 DOI: 10.1002/stem.3080] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/26/2019] [Indexed: 12/16/2022]
Abstract
Cellular therapy is a promising investigational modality to enhance poststroke recovery. We conducted a single-arm, phase I clinical trial to determine the safety and feasibility of intravenous (IV) administration of autologous bone marrow mononuclear cells (MNCs) after acute ischemic stroke (AIS). Patients with moderate severity of AIS underwent bone marrow harvest followed by IV reinfusion of MNCs within 24-72 hours of onset. A target dose of 10 million cells per kilogram was chosen based on preclinical data. Patients were followed up daily during hospitalization and at 1, 3, 6, 12, and 24 months for incidence of adverse events using laboratory, clinical (12 months), and radiological (24 months) parameters. The trial was powered to detect severe adverse events (SAEs) with incidences of at least 10% and planned to enroll 30 patients. Primary outcomes were study-related SAEs and the proportion of patients successfully completing study intervention. A propensity score-based matched control group was used for the estimation of effect size (ES) for day-90 modified Rankin score (mRS). There were no study-related SAEs and, based on a futility analysis, enrolment was stopped after 25 patients. All patients successfully completed study intervention and most received the target dose. Secondary analysis estimated the ES to be a reduction of 1 point (95% confidence interval: 0.33-1.67) in median day-90 mRS for treated patients as compared with the matched control group. Bone marrow harvest and infusion of MNCs is safe and feasible in patients with AIS. The estimated ES is helpful in designing future randomized controlled trials. Stem Cells 2019;37:1481-1491.
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Affiliation(s)
- Farhaan S Vahidy
- Institute for Stroke and Cerebrovascular Disease and Department of Neurology, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Muhammad E Haque
- Institute for Stroke and Cerebrovascular Disease and Department of Neurology, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Mohammad H Rahbar
- Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences (CCTS), UTHealth, Houston, Texas, USA
| | - Hongjian Zhu
- Department of Biostatistics and Data Science, School of Public Health, UTHealth, Houston, Texas, USA
| | - Paul Rowan
- Department of Health Policy and Management, School of Public Health, UTHealth, Houston, Texas, USA
| | - Imoigele P Aisiku
- Division of Emergency Critical Care, Department of Emergency Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Dean A Lee
- Division of Pediatrics, Cell Therapy Section, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Harinder S Juneja
- Hematology Division, Department of Medicine, UTHealth, Houston, Texas, USA
| | - Susan Alderman
- Institute for Stroke and Cerebrovascular Disease and Department of Neurology, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Andrew D Barreto
- Institute for Stroke and Cerebrovascular Disease and Department of Neurology, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Jose I Suarez
- Division of Neurosciences Critical Care, Department of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Arvind Bambhroliya
- Institute for Stroke and Cerebrovascular Disease and Department of Neurology, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Khader M Hasan
- Department of Diagnostic and Interventional Imaging, McGovern Medical School at UTHealth, Houston, Texas, USA
| | | | - Jaroslaw Aronowski
- Institute for Stroke and Cerebrovascular Disease and Department of Neurology, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Adrian Gee
- Department of Medicine and Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Charles S Cox
- Department of Pediatric Surgery, McGovern Medical School at UTHealth, Houston, Texas, USA
| | | | - Sean I Savitz
- Institute for Stroke and Cerebrovascular Disease and Department of Neurology, McGovern Medical School at UTHealth, Houston, Texas, USA
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Yamal JM, Hannay HJ, Gopinath S, Aisiku IP, Benoit JS, Robertson CS. Glasgow Outcome Scale Measures and Impact on Analysis and Results of a Randomized Clinical Trial of Severe Traumatic Brain Injury. J Neurotrauma 2019; 36:2484-2492. [PMID: 30973053 DOI: 10.1089/neu.2018.5939] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The original unstructured Glasgow Outcome Scale (uGOS) and the newer structured interviews GOS and the Extended GOS (GOS-E) have been used widely as outcomes in severe traumatic brain injury (TBI) trials. We compared outcome categories (ranging from dead [D] to good recovery [GR]) for each measure in a randomized trial of transfusion threshold and the implications of measure choice and analysis methods for the results of the trial. We planned to explore patient symptomology possibly driving any discrepancies between the patient's uGOS and GOS scores. Category correspondence between uGOS and GOS scores occurred in 160 (88.4%) of the 181 analyzed cases. The GOS-E and GOS instruments incorporated more behavioral/cognitive/social and other components, leading to a worse outcome in some cases than for the uGOS. Choice of outcome measure and analysis led to incongruous conclusions. Dichotomizing uGOS into favorable outcome (GR and moderate disability [MD] categories) versus unfavorable (severe disability [SD], vegetative state [VS], and D categories), we observed a significant effect of transfusion threshold (odds ratio [OR] = 0.51, p = 0.03; adjusted OR = 0.40, p = 0.02). For the same dichotomization of GOS and GOS-E, the effect was not statistically significant but the ORs were similar (ORs between 0.57 and 0.68, p > 0.15 for all). An effect was not detected using ordinal logistic regression or sliding dichotomy method for all three measures. Differences in categorizations of subjects between moderate and severe disability among the scales impacted conclusions of the trial. In future studies, particular attention should be given to implementing GOS measures and describing the methodology for how outcomes were ascertained.
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Affiliation(s)
- Jose-Miguel Yamal
- Coordinating Center for Clinical Trials, Department of Biostatistics and Data Science, The University of Texas School of Public Health, Houston, Texas
| | - H Julia Hannay
- Department of Psychology, University of Houston, Houston, Texas.,Texas Institute for Measurement Evaluation and Statistics (TIMES), University of Houston, Houston, Texas
| | - Shankar Gopinath
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Imoigele P Aisiku
- Harvard Medical School/Brigham and Women's Hospital, Boston, Massachusetts
| | - Julia S Benoit
- Texas Institute for Measurement Evaluation and Statistics (TIMES), University of Houston, Houston, Texas.,Department of Basic Vision Sciences, University of Houston, Houston, Texas
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Lee S, Hwang H, Yamal JM, Goodman JC, Aisiku IP, Gopinath S, Robertson CS. IMPACT probability of poor outcome and plasma cytokine concentrations are associated with multiple organ dysfunction syndrome following traumatic brain injury. J Neurosurg 2019; 131:1931-1937. [PMID: 30641838 DOI: 10.3171/2018.8.jns18676] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 08/14/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Traumatic brain injury (TBI) is a major cause of morbidity and mortality. Multiple organ dysfunction syndrome (MODS) occurs frequently after TBI and independently worsens outcome. The present study aimed to identify potential admission characteristics associated with post-TBI MODS. METHODS The authors performed a secondary analysis of a recent randomized clinical trial studying the effects of erythropoietin and blood transfusion threshold on neurological recovery after TBI. Admission clinical, demographic, laboratory, and imaging parameters were used in a multivariable Cox regression analysis to identify independent risk factors for MODS following TBI, defined as maximum total Sequential Organ Failure Assessment (SOFA) score > 7 within 10 days of TBI. RESULTS Two hundred patients were initially recruited and 166 were included in the final analysis. Respiratory dysfunction was the most common nonneurological organ system dysfunction, occurring in 62% of the patients. International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) probability of poor outcome at admission was significantly associated with MODS following TBI (odds ratio [OR] 8.88, 95% confidence interval [CI] 1.94-42.68, p < 0.05). However, more commonly used measures of TBI severity, such as the Glasgow Coma Scale, Injury Severity Scale, and Marshall classification, were not associated with post-TBI MODS. In addition, initial plasma concentrations of interleukin (IL)-6, IL-8, and IL-10 were significantly associated with the development of MODS (OR 1.47, 95% CI 1.20-1.80, p < 0.001 for IL-6; OR 1.26, 95% CI 1.01-1.58, p = 0.042 for IL-8; OR 1.77, 95% CI 1.24-2.53, p = 0.002 for IL-10) as well as individual organ dysfunction (SOFA component score ≥ 1). Finally, MODS following TBI was significantly associated with mortality (OR 5.95, 95% CI 2.18-19.14, p = 0.001), and SOFA score was significantly associated with poor outcome at 6 months (Glasgow Outcome Scale score < 4) when analyzed as a continuous variable (OR 1.21, 95% CI 1.06-1.40, p = 0.006). CONCLUSIONS Admission IMPACT probability of poor outcome and initial plasma concentrations of IL-6, IL-8, and IL-10 were associated with MODS following TBI.
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Affiliation(s)
| | - Hyunsoo Hwang
- 2Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas; and
| | - Jose-Miguel Yamal
- 2Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas; and
| | - J Clay Goodman
- 3Pathology & Immunology, Baylor College of Medicine, Houston
| | - Imoigele P Aisiku
- 4Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Hsu CH, Haac BE, Drake M, Bernard AC, Aiolfi A, Inaba K, Hinson HE, Agarwal C, Galante J, Tibbits EM, Johnson NJ, Carlbom D, Mirhoseini MF, Patel MB, O’Bosky KR, Chan C, Udekwu PO, Farrell M, Wild JL, Young KA, Cullinane DC, Gojmerac DJ, Weissman A, Callaway C, Perman SM, Guerrero M, Aisiku IP, Seethala RR, Co IN, Madhok DY, Darger B, Kim DY, Spence L, Scalea TM, Stein DM. EAST Multicenter Trial on targeted temperature management for hanging-induced cardiac arrest. J Trauma Acute Care Surg 2018; 85:37-47. [PMID: 29677083 PMCID: PMC6026030 DOI: 10.1097/ta.0000000000001945] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND We sought to determine the outcome of suicidal hanging and the impact of targeted temperature management (TTM) on hanging-induced cardiac arrest (CA) through an Eastern Association for the Surgery of Trauma (EAST) multicenter retrospective study. METHODS We analyzed hanging patient data and TTM variables from January 1992 to December 2015. Cerebral performance category score of 1 or 2 was considered good neurologic outcome, while cerebral performance category score of 3 or 4 was considered poor outcome. Classification and Regression Trees recursive partitioning was used to develop multivariate predictive models for survival and neurologic outcome. RESULTS A total of 692 hanging patients from 17 centers were analyzed for this study. Their overall survival rate was 77%, and the CA survival rate was 28.6%. The CA patients had significantly higher severity of illness and worse outcome than the non-CA patients. Of the 175 CA patients who survived to hospital admission, 81 patients (46.3%) received post-CA TTM. The unadjusted survival of TTM CA patients (24.7% vs 39.4%, p < 0.05) and good neurologic outcome (19.8% vs 37.2%, p < 0.05) were worse than non-TTM CA patients. However, when subgroup analyses were performed between those with an admission Glasgow Coma Scale score of 3 to 8, the differences between TTM and non-TTM CA survival (23.8% vs 30.0%, p = 0.37) and good neurologic outcome (18.8% vs 28.7%, p = 0.14) were not significant. Targeted temperature management implementation and post-CA management varied between the participating centers. Classification and Regression Trees models identified variables predictive of favorable and poor outcome for hanging and TTM patients with excellent accuracy. CONCLUSION Cardiac arrest hanging patients had worse outcome than non-CA patients. Targeted temperature management CA patients had worse unadjusted survival and neurologic outcome than non-TTM patients. These findings may be explained by their higher severity of illness, variable TTM implementation, and differences in post-CA management. Future prospective studies are necessary to ascertain the effect of TTM on hanging outcome and to validate our Classification and Regression Trees models. LEVEL OF EVIDENCE Therapeutic study, level IV; prognostic study, level III.
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Affiliation(s)
- Cindy H. Hsu
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
- University of Michigan, Ann Arbor, Michigan
| | - Bryce E. Haac
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mack Drake
- University of Kentucky, Lexington, Kentucky
| | | | - Alberto Aiolfi
- Los Angeles County/University of Southern California Medical Center, Los Angeles, CA
| | - Kenji Inaba
- Los Angeles County/University of Southern California Medical Center, Los Angeles, CA
| | | | | | - Joseph Galante
- University of California Davis Medical Center, Davis, California
| | - Emily M. Tibbits
- University of California Davis Medical Center, Davis, California
| | | | - David Carlbom
- University of Washington/Harborview Medical Center, Seattle, Washington
| | | | - Mayur B. Patel
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Christian Chan
- Loma Linda University Medical Center, Loma Linda, California
| | | | | | | | | | | | | | | | - Clifton Callaway
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | | | - Ivan N. Co
- University of Michigan, Ann Arbor, Michigan
| | - Debbie Y. Madhok
- San Francisco General Hospital/University of California San Francisco, San Francisco, California
| | - Bryan Darger
- San Francisco General Hospital/University of California San Francisco, San Francisco, California
| | | | - Lara Spence
- Harbor UCLA Medical Center, Torrance, California
| | - Thomas M. Scalea
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Deborah M. Stein
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
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Chao CC, Chen YC, Shih CM, Hou SK, Seethala RR, Aisiku IP, Huang CC, Hou PC, Kao WF. Smartphone transmission of electrocardiography images to reduce time of cardiac catheterization laboratory activation. J Chin Med Assoc 2018; 81:505-510. [PMID: 29287703 DOI: 10.1016/j.jcma.2017.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND This retrospective study evaluated the use of a smartphone application to facilitate communication between the emergency physician (EP) and the interventional cardiologist in order to minimize the time to cardiac catheterization laboratory (CCL) activation and time to percutaneous coronary intervention (PCI). METHODS We retrospectively collected pertinent time-points in the management of patients diagnosed with STEMI in the emergency department and their outcome. The primary outcome was the reduction in the time from ECG interpretation to CCL activation after the implementation of a smartphone application. A total of 84 patients were enrolled. Patients' electrocardiography (ECG) were described by traditional verbal communication via telephone (group 1, n = 40) and by additional smartphone transmission of ECG images to an interventional cardiologist (group 2, n = 44). Relevant time-points were recorded for analysis. RESULTS The time from ECG interpretation to CCL activation was reduced from 28.3 ± 4.1 in group 1 to 17.6 ± 2.3 min in group 2 (p = 0.03). Similarly, the time from ECG interpretation to balloon inflation time (D2B) decreased from 93.1 to 73.4 min (p = 0.025). Comparing group 2 with group 1, the door to balloon (D2B) time improved to 90.4 ± 9.8 from 119.3 ± 16.3 min (p = 0.23), the proportion of patients with a D2B time less than 90 min increased to 70.5% from 52.5% (p = 0.09), and the mortality rate decreased to 2.2% from 12.5% (p = 0.07). CONCLUSION The additional use of a smartphone application to transmit ECG information to interventional cardiologists by EPs facilitated communication and reduced the decision time to CCL activation and percutaneous intervention.
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Affiliation(s)
- Chun-Chieh Chao
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC; Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan, ROC; Graduate Institute of Clinical Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Yi-Chun Chen
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan, ROC
| | - Chun-Ming Shih
- Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan, ROC
| | - Sen-Kuang Hou
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC; Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan, ROC
| | - Raghu R Seethala
- Section of Emergency Medicine Critical Care, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Imoigele P Aisiku
- Section of Emergency Medicine Critical Care, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Chuan-Chin Huang
- Section of Emergency Medicine Critical Care, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Peter C Hou
- Section of Emergency Medicine Critical Care, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Wei-Fong Kao
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC; Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan, ROC.
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Cox CS, Hetz RA, Liao GP, Aertker BM, Ewing-Cobbs L, Juranek J, Savitz SI, Jackson ML, Romanowska-Pawliczek AM, Triolo F, Dash PK, Pedroza C, Lee DA, Worth L, Aisiku IP, Choi HA, Holcomb JB, Kitagawa RS. Treatment of Severe Adult Traumatic Brain Injury Using Bone Marrow Mononuclear Cells. Stem Cells 2017; 35:1065-1079. [PMID: 27800660 PMCID: PMC5367945 DOI: 10.1002/stem.2538] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 09/29/2016] [Accepted: 10/16/2016] [Indexed: 12/12/2022]
Abstract
Preclinical studies using bone marrow derived cells to treat traumatic brain injury have demonstrated efficacy in terms of blood-brain barrier preservation, neurogenesis, and functional outcomes. Phase 1 clinical trials using bone marrow mononuclear cells infused intravenously in children with severe traumatic brain injury demonstrated safety and potentially a central nervous system structural preservation treatment effect. This study sought to confirm the safety, logistic feasibility, and potential treatment effect size of structural preservation/inflammatory biomarker mitigation in adults to guide Phase 2 clinical trial design. Adults with severe traumatic brain injury (Glasgow Coma Scale 5-8) and without signs of irreversible brain injury were evaluated for entry into the trial. A dose escalation format was performed in 25 patients: 5 controls, followed 5 patients in each dosing cohort (6, 9, 12 ×106 cells/kg body weight), then 5 more controls. Bone marrow harvest, cell processing to isolate the mononuclear fraction, and re-infusion occurred within 48 hours after injury. Patients were monitored for harvest-related hemodynamic changes, infusional toxicity, and adverse events. Outcome measures included magnetic resonance imaging-based measurements of supratentorial and corpus callosal volumes as well as diffusion tensor imaging-based measurements of fractional anisotropy and mean diffusivity of the corpus callosum and the corticospinal tract at the level of the brainstem at 1 month and 6 months postinjury. Functional and neurocognitive outcomes were measured and correlated with imaging data. Inflammatory cytokine arrays were measured in the plasma pretreatment, posttreatment, and at 1 and 6 month follow-up. There were no serious adverse events. There was a mild pulmonary toxicity of the highest dose that was not clinically significant. Despite the treatment group having greater injury severity, there was structural preservation of critical regions of interest that correlated with functional outcomes. Key inflammatory cytokines were downregulated. Treatment of severe, adult traumatic brain injury using an intravenously delivered autologous bone marrow mononuclear cell infusion is safe and logistically feasible. There appears to be a treatment signal as evidenced by central nervous system structural preservation, consistent with previous pediatric trial data. Inflammatory biomarkers are downregulated after cell infusion. Stem Cells 2016 Video Highlight: https://youtu.be/UiCCPIe-IaQ Stem Cells 2017;35:1065-1079.
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Affiliation(s)
- Charles S Cox
- Department of Pediatric Surgery, The University of Texas McGovern Medical School, Houston, Texas, USA
| | - Robert A Hetz
- Department of Surgery, The University of Texas McGovern Medical School, Houston, Texas, USA
| | - George P Liao
- Department of Surgery, The University of Texas McGovern Medical School, Houston, Texas, USA
| | - Benjamin M Aertker
- Department of Neurology, The University of Texas McGovern Medical School, Houston, Texas, USA
| | - Linda Ewing-Cobbs
- Department of Pediatrics, The University of Texas McGovern Medical School, Houston, Texas, USA
- Department of Psychiatry and Behavioral Sciences, The University of Texas McGovern Medical School, Houston, Texas, USA
| | - Jenifer Juranek
- Department of Pediatrics, The University of Texas McGovern Medical School, Houston, Texas, USA
| | - Sean I Savitz
- Department of Neurology, The University of Texas McGovern Medical School, Houston, Texas, USA
| | - Margaret L Jackson
- Department of Pediatric Surgery, The University of Texas McGovern Medical School, Houston, Texas, USA
| | | | - Fabio Triolo
- Department of Pediatric Surgery, The University of Texas McGovern Medical School, Houston, Texas, USA
| | - Pramod K Dash
- Department of Neurobiology and Anatomy, The University of Texas McGovern Medical School, Houston, Texas, USA
| | - Claudia Pedroza
- Center for Clinical Research and Evidence-Based Medicine, The University of Texas McGovern Medical School, Houston, Texas, USA
| | - Dean A Lee
- Department of Hematology and Oncology, Nationwide Children's, Columbus, Ohio, USA
| | - Laura Worth
- Department of Pediatrics, MD Anderson Cancer Center, Houston, Texas, USA
| | - Imoigele P Aisiku
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Huimahn A Choi
- Department of Neurology, The University of Texas McGovern Medical School, Houston, Texas, USA
- Department of Neurosurgery, The University of Texas McGovern Medical School, Houston, Texas, USA
| | - John B Holcomb
- Department of Surgery, The University of Texas McGovern Medical School, Houston, Texas, USA
| | - Ryan S Kitagawa
- Department of Neurosurgery, The University of Texas McGovern Medical School, Houston, Texas, USA
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12
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Shih YN, Chen YT, Shih CJ, Ou SM, Hsu YT, Chen RC, Aisiku IP, Seethala RR, Frendl G, Hou PC. Association of weekend effect with early mortality in severe sepsis patients over time. J Infect 2017; 74:345-351. [DOI: 10.1016/j.jinf.2016.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/05/2016] [Accepted: 12/19/2016] [Indexed: 11/24/2022]
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Affiliation(s)
- Peter C Hou
- Division of Emergency Critical Care Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Raghu R Seethala
- Division of Emergency Critical Care Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Imoigele P Aisiku
- Division of Emergency Critical Care Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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14
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Shih YN, Chen YT, Chu H, Shih CJ, Ou SM, Hsu YT, Chen RC, Quraishi SA, Aisiku IP, Seethala RR, Frendl G, Hou PC. Association of pre-hospital theophylline use and mortality in chronic obstructive pulmonary disease patients with sepsis. Respir Med 2017; 125:33-38. [PMID: 28340860 DOI: 10.1016/j.rmed.2017.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 02/24/2017] [Accepted: 02/25/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although theophylline has been shown to have anti-inflammatory effects, the therapeutic use of theophylline before sepsis is unknown. The aim of our study was to determine the effect of theophylline on COPD patients presenting with sepsis. METHODS This nationwide, population-based, propensity score-matched analysis used data from the linked administrative databases of Taiwan's National Health Insurance program. Patients with COPD who were hospitalized for sepsis between 2000 and 2011 were divided into theophylline users and non-users. The primary outcome was 30-day mortality. The secondary outcome was in-hospital death, intensive care unit admission, and need for mechanical ventilation. Cox proportional hazard model and conditional logistic regression were used to calculate the risk between groups. RESULTS A propensity score-matched cohort of 51,801 theophylline users and 51,801 non-users was included. Compared with non-users, the 30-day (HR 0.931, 95% CI 0.910-0.953), 180-day (HR 0.930, 95% CI 0.914-0.946), 365-day (HR 0.944, 95% CI 0.929-0.960) and overall mortality (HR 0.965, 95% CI 0.952-0.979) were all significantly lower in theophylline users. Additionally, the theophylline users also had lower risk of in-hospital death (OR 0.895, 95% CI 0.873-0.918) and need for mechanical ventilation (OR 0.972, 95% CI 0.949-0.997). CONCLUSIONS Theophylline use is associated with a lower risk of sepsis-related mortality in COPD patients. Pre-hospital theophylline use may be protective to COPD patients with sepsis.
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Affiliation(s)
- Yu-Ning Shih
- Division of Emergency Critical Care Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, USA; Surgical ICU Translational Research (STAR) Center, Brigham and Women's Hospital, Boston, MA, USA; Department of Chest Medicine, Taipei City Hospital, Heping Fuyou Branch, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Harvard Medical School, Boston, MA, USA
| | - Yung-Tai Chen
- Department of Nephrology, Taipei City Hospital, Heping Fuyou Branch, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Hsi Chu
- Department of Chest Medicine, Taipei City Hospital, Heping Fuyou Branch, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chia-Jen Shih
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan, ROC
| | - Shuo-Ming Ou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yen-Tao Hsu
- Department of Chest Medicine, Taipei City Hospital, Heping Fuyou Branch, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ran-Chou Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Radiology, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan, ROC
| | - Sadeq A Quraishi
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Imoigele P Aisiku
- Division of Emergency Critical Care Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, USA; Harvard Medical School, Boston, MA, USA
| | - Raghu R Seethala
- Division of Emergency Critical Care Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, USA; Surgical ICU Translational Research (STAR) Center, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Gyorgy Frendl
- Surgical ICU Translational Research (STAR) Center, Brigham and Women's Hospital, Boston, MA, USA; Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Peter C Hou
- Division of Emergency Critical Care Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, USA; Surgical ICU Translational Research (STAR) Center, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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15
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Seethala RR, Hou PC, Aisiku IP, Frendl G, Park PK, Mikkelsen ME, Chang SY, Gajic O, Sevransky J. Early risk factors and the role of fluid administration in developing acute respiratory distress syndrome in septic patients. Ann Intensive Care 2017; 7:11. [PMID: 28116595 PMCID: PMC5256622 DOI: 10.1186/s13613-017-0233-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 01/07/2017] [Indexed: 12/29/2022] Open
Abstract
Background Sepsis is a major risk factor for acute respiratory distress syndrome (ARDS). However, there remains a paucity of literature examining risk factors for ARDS in septic patients early in their course. This study examined the role of early fluid administration and identified other risk factors within the first 6 h of hospital presentation associated with developing ARDS in septic patients. Methods This was a secondary analysis of septic adult patients presenting to the Emergency Department or being admitted for high-risk elective surgery from the multicenter observational cohort study, US Critical Injury and Illness trial Group-Lung Injury Prevention Study 1 (USCIITG-LIPS 1, NCT00889772). Multivariable logistic regression was performed to identify potential early risk factors for ARDS. Stratified analysis by shock status was performed to examine the association between early fluid administration and ARDS. Results Of the 5584 patients in the original study cohort, 2534 (45.4%) met our criteria for sepsis. One hundred and fifty-six (6.2%) of these patients developed ARDS during the hospital stay. In multivariable analyses, Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR 1.10, 95% CI 1.07–1.13), age (OR 0.97, 95% CI 0.96–0.98), total fluid infused in the first 6 h (in liters) (OR 1.15, 95% CI 1.03–1.29), shock (OR 2.57, 95% CI 1.62–4.08), pneumonia as a site of infection (OR 2.31, 95% CI 1.59–3.36), pancreatitis (OR 3.86, 95% CI 1.33–11.24), and acute abdomen (OR 3.77, 95% CI 1.37–10.41) were associated with developing ARDS. In the stratified analysis, total fluid infused in the first 6 h (in liters) (OR 1.05, 95% CI 0.87–1.28) was not associated with the development of ARDS in the shock group, while there was an association in the non-shock group (OR 1.21, 95% CI 1.05–1.38). Conclusions In septic patients, the following risk factors identified within the first 6 h of hospital presentation were associated with ARDS: APACHE II score, presence of shock, pulmonary source of infection, pancreatitis, and presence of an acute abdomen. In septic patients without shock, the amount of fluid infused during the first 6 h of hospital presentation was associated with developing ARDS. Electronic supplementary material The online version of this article (doi:10.1186/s13613-017-0233-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Raghu R Seethala
- Division of Emergency Critical Care Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St., Neville House, Boston, MA, 02115, USA. .,Surgical ICU Translational Research (STAR) Center, Brigham and Women's Hospital, Boston, MA, USA.
| | - Peter C Hou
- Division of Emergency Critical Care Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St., Neville House, Boston, MA, 02115, USA.,Surgical ICU Translational Research (STAR) Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Imoigele P Aisiku
- Division of Emergency Critical Care Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St., Neville House, Boston, MA, 02115, USA
| | - Gyorgy Frendl
- Surgical ICU Translational Research (STAR) Center, Brigham and Women's Hospital, Boston, MA, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Pauline K Park
- Division of Acute Care Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Mark E Mikkelsen
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Steven Y Chang
- Division of Pulmonary and Critical Care, Department of Medicine, UCLA, Los Angeles, CA, USA
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jonathan Sevransky
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Emory University, Atlanta, GA, USA
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16
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Smith WR, McClish DK, Dahman BA, Levenson JL, Aisiku IP, de A Citero V, Bovbjerg VE, Roberts JD, Penberthy LT, Roseff SD. Daily home opioid use in adults with sickle cell disease: The PiSCES project. J Opioid Manag 2015; 11:243-253. [PMID: 25985809 DOI: 10.5055/jom.2015.0273] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Although opioid prescribing in sickle cell disease (SCD) can be controversial, little is published about patterns of opioid use. OBJECTIVE To report on home opioid use among adults with SCD. DESIGN Cohort study. PARTICIPANTS Adults with SCD (n=219) who completed daily pain diaries for up to 6 months and had at least one home pain day. MAIN MEASURES Use of long-acting or short-acting opioids, other analgesics, or adjuvants; the proportion of home days, home pain days, and home crisis days with opioid use; these two outcomes according to patient characteristics. KEY RESULTS Patients used opioids on 12,311 (78 percent) of 15,778 home pain days. Eighty-five patients (38.8 percent) used long-acting opioids with or without short-acting opioids and 103 (47.0 percent) used only short-acting opioids. Twenty-one (9.6 percent) patients used only non-opioid analgesics and 10 (4.6 percent) used no analgesics. Both pain intensity and pain frequency were higher among opioid users (analysis of variance [ANOVA], p<0.0001). Opioid users used hydroxyurea more often than nonusers, even when controlling for mean pain on pain days. Among all patients, significant relationships were found between any opioid use and somatic symptom burden, SCD stress, negative coping, and physical and mental quality of life (QOL); the relationship with SCD stress and physical QOL remained when controlled for mean pain. Among opioid users, similar associations were found between frequency of opioid use and some disease-related and psychosocial variables. CONCLUSIONS In this adult SCD sample, opioids were used by the majority of patients. Pain was the overwhelming characteristic associated with use, but disease-related and psychosocial variables were also associated.
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Affiliation(s)
- Wally R Smith
- Florence Neal Cooper Smith Professor of Sickle Cell Disease, Division of General Internal Medicine, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Donna K McClish
- Professor, Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Bassam A Dahman
- Assistant Professor, Healthcare Policy and Research, Virginia Commonwealth University, Richmond, Virginia
| | - James L Levenson
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia
| | - Imoigele P Aisiku
- Assistant Professor, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Vanessa de A Citero
- Dept. de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Viktor E Bovbjerg
- Associate Professor, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
| | - John D Roberts
- Professor, Section of Medical Oncology, Department of Medicine, Director, Yale Adult Sickle Cell Program, Smilow Cancer Hospital at Yale - New Haven, New Haven, Connecticut
| | - Lynne T Penberthy
- Associate Director, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Susan D Roseff
- Chair, Division of Clinical Pathology, Department of Pathology, Virginia Commonwealth University, Richmond, Virginia
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Yamal JM, Rubin ML, Benoit JS, Tilley BC, Gopinath S, Hannay HJ, Doshi P, Aisiku IP, Robertson CS. Effect of Hemoglobin Transfusion Threshold on Cerebral Hemodynamics and Oxygenation. J Neurotrauma 2015; 32:1239-45. [PMID: 25566694 DOI: 10.1089/neu.2014.3752] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Cerebral dysfunction caused by traumatic brain injury may adversely affect cerebral hemodynamics and oxygenation leading to worse outcomes if oxygen capacity is decreased due to anemia. In a randomized clinical trial of 200 patients comparing transfusion thresholds <7 g/dl versus 10 g/dl, where transfusion of leukoreduced packed red blood cells was used to maintain the assigned hemoglobin threshold, no long-term neurological difference was detected. The current study examines secondary outcome measures of intracranial pressure (ICP), cerebral perfusion pressure (CPP), and brain tissue oxygenation (PbtO2) in patients enrolled in this randomized clinical trial. We observed a lower hazard for death (hazard ratio [HR]=0.12, 95% confidence interval [CI]=0.02-0.99) during the first 3 days post-injury, and a higher hazard for death after three days (HR=2.55, 95% CI=1.00-6.53) in the 10 g/dl threshold group as compared to the 7 g/dL threshold group. No significant differences were observed for ICP and CPP but MAP was slightly lower in the 7 g/dL group, although the decreased MAP did not result in increased hypotension. Overall brain tissue hypoxia events were not significantly different in the two transfusion threshold groups. When the PbtO2 catheter was placed in normal brain, however, tissue hypoxia occurred in 25% of patients in the 7 g/dL threshold group, compared to 10.2% of patients in the 10 g/dL threshold group (p=0.04). Although we observed a few differences in hemodynamic outcomes between the transfusion threshold groups, none were of major clinical significance and did not affect long-term neurological outcome and mortality.
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Affiliation(s)
- Jose-Miguel Yamal
- 1 Department of Biostatistics, University of Texas School of Public Health , Houston, Texas
| | - M Laura Rubin
- 1 Department of Biostatistics, University of Texas School of Public Health , Houston, Texas
| | - Julia S Benoit
- 2 Department of Basic Vision Sciences, College of Optometry and Texas Institute for Measurement Evaluation and Statistics, University of Houston , Houston, Texas
| | - Barbara C Tilley
- 1 Department of Biostatistics, University of Texas School of Public Health , Houston, Texas
| | - Shankar Gopinath
- 3 Department of Neurosurgery, Baylor College of Medicine , Houston, Texas
| | - H Julia Hannay
- 4 Department of Psychology, University of Houston , Houston, Texas
| | - Pratik Doshi
- 5 Department of Emergency Medicine and Internal Medicine, University of Texas Health Science Center at Houston , Houston, Texas
| | - Imoigele P Aisiku
- 6 Department of Emergency Medicine, Brigham and Women's Hospital , Boston, Massachusetts
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18
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Robertson CS, Hannay HJ, Yamal JM, Gopinath S, Goodman JC, Tilley BC, Baldwin A, Rivera Lara L, Saucedo-Crespo H, Ahmed O, Sadasivan S, Ponce L, Cruz-Navarro J, Shahin H, Aisiku IP, Doshi P, Valadka A, Neipert L, Waguspack JM, Rubin ML, Benoit JS, Swank P. Effect of erythropoietin and transfusion threshold on neurological recovery after traumatic brain injury: a randomized clinical trial. JAMA 2014; 312:36-47. [PMID: 25058216 PMCID: PMC4113910 DOI: 10.1001/jama.2014.6490] [Citation(s) in RCA: 333] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE There is limited information about the effect of erythropoietin or a high hemoglobin transfusion threshold after a traumatic brain injury. OBJECTIVE To compare the effects of erythropoietin and 2 hemoglobin transfusion thresholds (7 and 10 g/dL) on neurological recovery after traumatic brain injury. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial of 200 patients (erythropoietin, n = 102; placebo, n = 98) with closed head injury who were unable to follow commands and were enrolled within 6 hours of injury at neurosurgical intensive care units in 2 US level I trauma centers between May 2006 and August 2012. The study used a factorial design to test whether erythropoietin would fail to improve favorable outcomes by 20% and whether a hemoglobin transfusion threshold of greater than 10 g/dL would increase favorable outcomes without increasing complications. Erythropoietin or placebo was initially dosed daily for 3 days and then weekly for 2 more weeks (n = 74) and then the 24- and 48-hour doses were stopped for the remainder of the patients (n = 126). There were 99 patients assigned to a hemoglobin transfusion threshold of 7 g/dL and 101 patients assigned to 10 g/dL. INTERVENTIONS Intravenous erythropoietin (500 IU/kg per dose) or saline. Transfusion threshold maintained with packed red blood cells. MAIN OUTCOMES AND MEASURES Glasgow Outcome Scale score dichotomized as favorable (good recovery and moderate disability) or unfavorable (severe disability, vegetative, or dead) at 6 months postinjury. RESULTS There was no interaction between erythropoietin and hemoglobin transfusion threshold. Compared with placebo (favorable outcome rate: 34/89 [38.2%; 95% CI, 28.1% to 49.1%]), both erythropoietin groups were futile (first dosing regimen: 17/35 [48.6%; 95% CI, 31.4% to 66.0%], P = .13; second dosing regimen: 17/57 [29.8%; 95% CI, 18.4% to 43.4%], P < .001). Favorable outcome rates were 37/87 (42.5%) for the hemoglobin transfusion threshold of 7 g/dL and 31/94 (33.0%) for 10 g/dL (95% CI for the difference, -0.06 to 0.25, P = .28). There was a higher incidence of thromboembolic events for the transfusion threshold of 10 g/dL (22/101 [21.8%] vs 8/99 [8.1%] for the threshold of 7 g/dL, odds ratio, 0.32 [95% CI, 0.12 to 0.79], P = .009). CONCLUSIONS AND RELEVANCE In patients with closed head injury, neither the administration of erythropoietin nor maintaining hemoglobin concentration of greater than 10 g/dL resulted in improved neurological outcome at 6 months. The transfusion threshold of 10 g/dL was associated with a higher incidence of adverse events. These findings do not support either approach in this setting. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00313716.
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Affiliation(s)
| | - H Julia Hannay
- Department of Psychology, University of Houston, Houston, Texas
| | - José-Miguel Yamal
- Division of Biostatistics, University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Shankar Gopinath
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - J Clay Goodman
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Barbara C Tilley
- Division of Biostatistics, University of Texas Health Science Center at Houston School of Public Health, Houston
| | | | - Athena Baldwin
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Lucia Rivera Lara
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | - Osama Ahmed
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | - Luciano Ponce
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | - Hazem Shahin
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | - Pratik Doshi
- University of Texas Health Sciences Center, Houston
| | - Alex Valadka
- University of Texas Health Sciences Center, Houston
| | - Leslie Neipert
- Department of Psychology, University of Houston, Houston, Texas
| | | | - M Laura Rubin
- Division of Biostatistics, University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Julia S Benoit
- Division of Biostatistics, University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Paul Swank
- Division of Biostatistics, University of Texas Health Science Center at Houston School of Public Health, Houston
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Aisiku IP, Smith WR, McClish DK, Levenson JL, Penberthy LT, Roseff SD, Bovbjerg VE, Roberts JD. Comparisons of high versus low emergency department utilizers in sickle cell disease. Ann Emerg Med 2008; 53:587-93. [PMID: 18926599 DOI: 10.1016/j.annemergmed.2008.07.050] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 07/12/2008] [Accepted: 07/30/2008] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE Patients with sickle cell disease often receive a substantial amount of their health care in the emergency department (ED) and some come to the ED frequently, seeking treatment for pain. As a result, patients with sickle cell disease are often stigmatized as opioid-seeking ED overutilizers. We describe the proportion of sickle cell disease patients who are high utilizers of the ED and compare them with other sickle cell disease patients on demographics, pain characteristics, health data, psychosocial characteristics, and quality of life. METHODS Two hundred thirty-two patients completed baseline data and at least 30 days of daily diary data. Baseline data included demographics, health data, and quality of life (Medical Outcome Study 36 Item Short Form). Daily diary data included ED utilization for sickle cell pain and descriptors of pain and distress. RESULTS Eighty-two (35.5%) patients were found to be high ED utilizers. Clinically important and statistically significant differences were found between high ED utilizers and all other sickle cell disease patients: lower hematocrit level, more transfusions, more pain days, more pain crises, higher mean pain and distress, and worse quality of life on Medical Outcome Study 36 Item Short Form physical function summary scales. After controlling for severity and frequency of pain, high ED utilizers did not use opioids more frequently than other sickle cell disease patients. CONCLUSION A substantial minority of sickle cell disease patients are high ED utilizers. However, high ED utilizers with sickle cell disease are more severely ill as measured by laboratory variables, have more pain, more distress, and have a lower quality of life.
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Affiliation(s)
- Imoigele P Aisiku
- Department of Anesthesiology, Virginia Commonwealth University Reanimation Engineering Shock Center, Virginia Commonwealth University, Richmond, VA 23298, USA.
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Smith WR, Penberthy LT, Bovbjerg VE, McClish DK, Roberts JD, Dahman B, Aisiku IP, Levenson JL, Roseff SD. Daily assessment of pain in adults with sickle cell disease. Ann Intern Med 2008; 148:94-101. [PMID: 18195334 DOI: 10.7326/0003-4819-148-2-200801150-00004] [Citation(s) in RCA: 408] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Researchers of sickle cell disease have traditionally used health care utilization as a proxy for pain and underlying vaso-occlusion. However, utilization may not completely reflect the amount of self-reported pain or acute, painful episodes (crises). OBJECTIVE To examine the prevalence of self-reported pain and the relationship among pain, crises, and utilization in adults with sickle cell disease. DESIGN Prospective cohort study. SETTING Academic and community practices in Virginia. PATIENTS 232 patients age 16 years or older with sickle cell disease. MEASUREMENTS Patients completed a daily diary for up to 6 months, recording their maximum pain (on a scale of 0 to 9); whether they were in a crisis (crisis day); and whether they used hospital, emergency, or unscheduled ambulatory care for pain on the previous day (utilization day). Summary measures included both simple proportions and adjusted probabilities (for repeated measures within patients) of pain days, crisis days, and utilization days, as well as mean pain intensity. RESULTS Pain (with or without crisis or utilization of care) was reported on 54.5% of 31 017 analyzed patient-days (adjusted probability, 56%). Crises without utilization were reported on 12.7% of days and utilization on only 3.5% (unadjusted). In total, 29.3% of patients reported pain in greater than 95% of diary days, whereas only 14.2% reported pain in 5% or fewer diary days (adjusted). The frequency of home opiate use varied and independently predicted pain, crises, and utilization. Mean pain intensity on crisis days, noncrisis pain days, and total pain days increased as the percentage of pain days increased (P < 0.001). Intensity was significantly higher on utilization days (P < 0.001). However, utilization was not an independent predictor of crisis, after controlling for pain intensity. LIMITATIONS The study was done in a single state. Patients did not always send in their diaries. CONCLUSION Pain in adults with sickle cell disease is the rule rather than the exception and is far more prevalent and severe than previous large-scale studies have portrayed. It is mostly managed at home; therefore, its prevalence is probably underestimated by health care providers, resulting in misclassification, distorted communication, and undertreatment.
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Affiliation(s)
- Wally R Smith
- Division of Quality Health Care, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia 23298, USA.
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Aisiku IP, Penberthy LT, Smith WR, Bovbjerg VE, McClish DK, Levenson JL, Roberts JD, Roseff SD. Patient satisfaction in specialized versus nonspecialized adult sickle cell care centers: the PiSCES study. J Natl Med Assoc 2007; 99:886-90. [PMID: 17722665 PMCID: PMC2574305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) patients can receive their ambulatory care from either SCD specialists (caregivers with sickle cell-only clinics) or nonspecialized care centers. Patient satisfaction, an important factor that may influence compliance and outcome, can differ between the two groups because of the perceived quality of care, outcomes or practice style. METHODS We administered a patient satisfaction survey to 308 participants in an SCD prospective cohort study. Of the 308 patients, 133 (43.2%) received the majority of their SCD care at specialized centers, 152 (49.3%) received their care from nonspecialized centers and 26 (7.5) did not provide information. The satisfaction surveys measured general satisfaction (GS), technical quality (TQ), interpersonal manner (IM), communication (CM), financial aspects (FA), time spent with doctor (TA), and accessibility and convenience (AC). Patients reported their levels of satisfaction using a five-point Likert scale. We compared unadjusted group means, as well as means adjusted for potential confounders such as marital status, on patient satisfaction between specialized and nonspecialized centers. RESULTS SCD patients who received their care from specialized centers had significantly higher mean satisfaction scores, compared to those who received their care from nonspecialized centers: GS 4.00(+/-0.93) vs. 3.66 (+/- 01.16, p=0.0326), TQ 3.98 (+/- 0.77) vs. 3.65 (+/- 0.91, p=0.0058), AC 3.83 (+/-0.79) vs. 3.51 (+/- 1.02, p=0.0142) , FA 3.88 (+/-0.96) vs. 3.49 (+/-1.25, p=0.0120). There were no statistically significant group differences in IM, TA and CM. CONCLUSION SCD patients who received most of their SCD care from specialized centers had somewhat higher satisfaction scores in some areas when compared with patients who received their care from nonspecialized centers.
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Affiliation(s)
- Imoigele P Aisiku
- Department of Anesthesia/Critical Care & Emergency Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA.
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Citero VDA, Levenson JL, McClish DK, Bovbjerg VE, Cole PL, Dahman BA, Penberthy LT, Aisiku IP, Roseff SD, Smith WR. The role of catastrophizing in sickle cell disease--the PiSCES project. Pain 2007; 133:39-46. [PMID: 17408858 DOI: 10.1016/j.pain.2007.02.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Revised: 02/14/2007] [Accepted: 02/14/2007] [Indexed: 10/23/2022]
Abstract
In several types of chronic pain, catastrophizing has been related to higher pain intensity, and health care utilization but it has not been explored extensively in sickle cell disease (SCD). The objective of the study was to identify the role of catastrophizing in SCD, specifically in relation to painful crises, non-crisis pain, and responses to pain. Two hundred and twenty SCD adults were enrolled in a prospective cohort study of pain and completed between 30 and 188 daily diaries in 6 months. The Catastrophizing subscale (CAT) of the Coping Strategy Questionnaire (CSQ) was administered at baseline and at study exit. Depression and quality of life were measured by the Patient Health Questionnaire and SF-36, respectively, at baseline. The CAT mean was 13.6 (SD=8.4) and higher CAT was correlated with greater depression severity (r=0.48; p<0.001) and poorer quality of life in all domains (r=-0.24 to -0.47; p<0.001). There was no significance difference between CAT mean baseline and exit scores, and the measures were strongly correlated within patients (r=0.69; p<0.001). No difference was found between higher and lower catastrophizers in intensity of pain, distress, interference, and health service utilization, both on crisis or non-crisis SCD-related pain days, after controlling for depression. Adults with SCD had a higher mean catastrophizing score than found in studies of other chronic pain conditions that are not lifelong and life-threatening. CAT scores were not correlated with pain parameters or utilization. The role of catastrophizing in other conditions cannot be generalized to SCD.
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Affiliation(s)
- Vanessa de A Citero
- Department of Psychiatry, Division of Consultation-Liaison, Virginia Commonwealth University, Richmond, VA, USA.
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Levenson JL, McClish DK, Dahman BA, Penberthy LT, Bovbjerg VE, Aisiku IP, Roseff SD, Smith WR. Alcohol Abuse in Sickle Cell Disease: The Pisces Project. Am J Addict 2007; 16:383-8. [PMID: 17882609 DOI: 10.1080/10550490701525434] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Alcohol abuse is common in patients with chronic painful medical disorders, but it has not been studied in sickle cell disease (SCD). In a prospective cohort study of SCD adults, 31.4% were identified as abusing alcohol. There were no significant differences between alcohol abusers and nonabusers on demographics, biological variables, depression, anxiety, measures of crisis and noncrisis pain, or opioid use, but abusers reported more pain relief from opioids than nonabusers did. Alcohol abusers had fewer unscheduled clinic visits, emergency room visits, hospital days, and any health care utilization for SCD, but this was only significant for emergency room visits. Quality of life was similar between both groups, except that alcohol abusers unexpectedly had better overall physical summary scores. Alcohol abusers were more likely to report coping by ignoring pain, diverting attention, and using particular self-statements.
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Affiliation(s)
- James L Levenson
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA 23298, USA.
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McClish DK, Levenson JL, Penberthy LT, Roseff SD, Bovbjerg VE, Roberts JD, Aisiku IP, Smith WR. Gender Differences in Pain and Healthcare Utilization for Adult Sickle Cell Patients: The PiSCES Project. J Womens Health (Larchmt) 2006; 15:146-54. [PMID: 16536678 DOI: 10.1089/jwh.2006.15.146] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Many studies have found gender differences in frequency and intensity of pain. Women often report lower pain thresholds, higher pain ratings, and lower tolerance for pain. People with sickle cell disease (SCD) experience both chronic and acute pain throughout life. OBJECTIVES To compare adult men and women with SCD in terms of reported pain, crises, healthcare utilization, and opioid usage. METHODS Two hundred twenty-six adults with SCD in Virginia were enrolled in a prospective cohort study of pain and completed daily diaries for 1-6 months. Subjects reported for the previous day their maximum SCD-related pain, distress, and interference (0-9 scale), whether they were in a sickle cell crisis, had unplanned utilization (clinic, emergency room, or hospitalization), or used opioids. Episodes of pain, crisis, or utilization were defined as consecutive days of such. Men and women were compared, using analysis of covariance (ANCOVA), controlling for age, SCD genotype, depression, and education. RESULTS There were no significant differences between men and women in the percentage of days subjects experienced pain (men 58.6% vs. women 56.5%) or the number of pain episodes/6 months (7.7 vs. 9.6). Mean pain scores were comparable, when subjects were in crisis (5.5 vs. 5.6) or not (2.5 vs. 2.2). Distress and interference results were similar. Men with the SS genotype reported a higher percentage of days with crisis(18.5% vs. 11.6%) and utilization (5.1% vs. 2.7%) than women with the SS genotype. CONCLUSIONS Contrary to many studies of pain, particularly chronic pain, men and women with SCD reported generally similar pain experiences.
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Affiliation(s)
- Donna K McClish
- Department of Biostatistics, Virginia Commonwealth University, Richmond, 23298-0032, USA.
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McClish DK, Penberthy LT, Bovbjerg VE, Roberts JD, Aisiku IP, Levenson JL, Roseff SD, Smith WR. Health related quality of life in sickle cell patients: the PiSCES project. Health Qual Life Outcomes 2005; 3:50. [PMID: 16129027 PMCID: PMC1253526 DOI: 10.1186/1477-7525-3-50] [Citation(s) in RCA: 171] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2005] [Accepted: 08/29/2005] [Indexed: 11/16/2022] Open
Abstract
Background Sickle cell disease (SCD) is a chronic disease associated with high degrees of morbidity and increased mortality. Health-related quality of life (HRQOL) among adults with sickle cell disease has not been widely reported. Methods We administered the Medical Outcomes Study 36-item Short-Form to 308 patients in the Pain in Sickle Cell Epidemiology Study (PiSCES) to assess HRQOL. Scales included physical function, physical and emotional role function, bodily pain, vitality, social function, mental health, and general health. We compared scores with national norms using t-tests, and with three chronic disease cohorts: asthma, cystic fibrosis and hemodialysis patients using analysis of variance and Dunnett's test for comparison with a control. We also assessed whether SCD specific variables (genotype, pain, crisis and utilization) were independently predictive of SF-36 subscales, controlling for socio-demographic variables using regression. Results Patients with SCD scored significantly worse than national norms on all subscales except mental health. Patients with SCD had lower HRQOL than cystic fibrosis patients except for mental health. Scores were similar for physical function, role function and mental health as compared to asthma patients, but worse for bodily pain, vitality, social function and general health subscales. Compared to dialysis patients, sickle cell disease patients scored similarly on physical role and emotional role function, social functioning and mental health, worse on bodily pain, general health and vitality and better on physical functioning. Surprisingly, genotype did not influence HRQOL except for vitality. However, scores significantly decreased as pain levels increased. Conclusion SCD patients experience health related quality of life worse than the general population, and in general, their scores were most similar to patients undergoing hemodialysis. Practitioners should regard their HRQOL as severely compromised. Interventions in SCD should consider improvements in health related quality of life as important outcomes.
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Affiliation(s)
- Donna K McClish
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
- Division of Quality Health Care, Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Lynne T Penberthy
- Division of Quality Health Care, Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Viktor E Bovbjerg
- Department of Health Evaluation Sciences, University of Virginia, Charlottesville, VA, USA
| | - John D Roberts
- Division of Hematology/Oncology, Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Imoigele P Aisiku
- Division of Quality Health Care, Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - James L Levenson
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Susan D Roseff
- Department of Pathology, Virginia Commonwealth University, Richmond, VA, USA
| | - Wally R Smith
- Division of Quality Health Care, Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
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Smith WR, Bovbjerg VE, Penberthy LT, McClish DK, Levenson JL, Roberts JD, Gil K, Roseff SD, Aisiku IP. Understanding pain and improving management of sickle cell disease: the PiSCES study. J Natl Med Assoc 2005; 97:183-93. [PMID: 15712781 PMCID: PMC2568749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Until recent decades, sickle cell disease (SCD) was associated with recurrent, disabling pain, organ failure and death in childhood or early adulthood. SCD treatment advances have now decreased pain and prolonged survival, but episodic or chronic pain may still require substantial analgesic use and frequent hospitalization for pain episodes. This pain is poorly characterized and often poorly treated. Adult patients may face barriers to comprehensive SCD care, stigmatization of their care-seeking behavior by providers and lack of family support, forcing them into maladaptive coping strategies. The Pain in Sickle Cell Epidemiology Study (PiSCES) attempts to develop and validate a biopsychosocial model of SCD pain, pain response and healthcare utilization in a large, multisite adult cohort. PiSCES participants complete a baseline survey and six months of daily pain diaries in which they record levels of SCD-related pain and related disability and distress as well as responses to pain (e.g., medication use, hospital visits). PiSCES will advance methods of measuring pain and pain response in SCD by better describing home-managed as well as provider-managed pain. PiSCES will assess the relative contributions of biological (disease-related), psychosocial and environmental (readiness to utilize) factors to overall pain and pain response in SCD, suggesting targets for biobehavioral interventions over time. Importantly, PiSCES will also identify "triggers" of SCD pain episodes and healthcare utilization in the moment of pain, suggesting targets for timely care that mutes pain episodes.
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Affiliation(s)
- Wally R Smith
- Virginia Commonwealth University, Division of Quality Health Care, Box 980306, Richmond, VA 23298, USA.
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Ander DS, Aisiku IP, Ratcliff JJ, Todd KH, Gotsch K. Measuring the Dyspnea of Decompensated Heart Failure With a Visual Analog Scale: How Much Improvement Is Meaningful? ACTA ACUST UNITED AC 2004; 10:188-91. [PMID: 15314477 DOI: 10.1111/j.1527-5299.2004.03475.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patients presenting to the emergency department with heart failure are evaluated based on the subjective sensation of dyspnea. In this study, the authors sought to determine the change in dyspnea, measured by a visual analog scale (VAS), which is associated with a meaningful change in the patient's perception and the effect of dyspnea severity on the VAS. In this prospective, observational study the authors defined a meaningful change in VAS dyspnea as the difference between VAS scores when patients reported "a little less difficulty breathing" or "a little more difficulty breathing." Seventy-four patients were evaluated, and the mean for a meaningful change in VAS was 21.1 mm (95% confidence interval, 12.3-29.9 mm). Patients that recorded higher index VAS scores had a significantly greater change in VAS. VAS scores and the changes with treatment provide the treating physician with another means to assess the effects of their interventions.
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Affiliation(s)
- Douglas S Ander
- Department of Emergency Medicine, Emory University, Atlanta, GA, USA.
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